Healthcare Provider Details

I. General information

NPI: 1649511320
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PALMETTO HEALTH PKWY SUITE 250B
COLUMBIA SC
29212-1753
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-407-3734
  • Fax: 803-407-3133
Mailing address:
  • Phone: 803-296-7305
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARRELL COVEN
Title or Position: DIRECTOR, AMBULATORY SERVICES-FIN
Credential:
Phone: 803-296-7301